Medications for Treating Type 2 Diabetes
The first way to treat type 2 diabetes is often meal planning, weight loss, and exercise. Often these
steps are not enough to bring blood glucose levels down to a healthy range. The next step is taking
medication that lowers blood glucose levels.
Your doctor will decide which medication is right for you.
This depends on:
• your lifestyle
• how you respond to the medicine
• physical condition
• insurance coverage
ORAL MEDICATIONS
There are different types, or classes, of drugs that work in different ways to lower blood glucose.
Sulfonylureas chlorpropamide, (Diabinese), glipizide (Glucotrol and Glucotrol XL), glyburide
(Micronase, Glynase, and Diabeta), glimepiride (Amaryl)
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin.
Biguanides metformin (Glucophage)
Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by
the liver. They also help to lower blood glucose levels by making muscle tissue more sensitive to
insulin so glucose can be absorbed.
Meglitinides repaglinide (Prandin), nateglinide (Starlix)
Meglitinides are drugs that also stimulate the beta cells to release insulin.
Thiazolidinediones rosiglitazone (Avandia), pioglitazone (ACTOS)
Thiazolidinediones drugs help insulin work better in the muscle and fat and also reduce glucose
production in the liver.
DPP-4 Inhibitors sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin
(Nesina)
DPP-4 Inhibitors work by preventing the breakdown of a naturally occurring compound in the body,
GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does
not work well when injected as a drug itself. By interfering in the process that breaks down GLP1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only
when they are high.
SGLT2 Inhibitors canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance)
Glucose in the blood passes through the kidneys. Sodium-glucose transporter 2 (SGLT2) works
naturally in the kidney to reabsorb glucose, and SGLT2 inhibitors block this action, causing excess
glucose to be eliminated in the urine.
Alpha-Glucosidase Inhibitors acarbose (Precose), meglitol (Glyset)
Alpha glucosidase inhibitors help the body to lower blood glucose levels by blocking the breakdown
of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of
some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal.
Bile Acid Sequestrants (BAS) colesevelam (Welchol)
The BAS colesevelam is a cholesterol-lowering medication that also reduces blood glucose levels in
patients with diabetes.
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Oral Combination Therapy
Because the drugs listed above act in different ways to lower blood glucose levels, they may be used
together. For example, a biguanide and a sulfonylurea may be used together. Many combinations are
prescribed together as a single pill for convenience.
INSULIN
There are different types of insulin that vary in how quickly they lower blood glucose levels. Some
work very quickly and are taken with meals. Others are long-acting and are used just once or twice a
day.
Rapid Acting insulin glulisine (Apidra), insulin lispro (Humalog), insulin aspart (NovoLog)
Onset: about 15 minutes
Peak: about 1or 2 hours after injection
Duration: last between 2-4 hours
Regular or Short-Acting regular (Humulin R and Novolin R)
Onset: about 30 minutes
Peak: about 2 to 3 hours after injection
Duration: last between 3-6 hours
Intermediate-Acting NPH (Humulin N and Novolin N)
Onset: about 2 to 4 hours after injection
Peak: 4 to 12 hours later
Duration: it is effective for about 12 to 18 hours
Long-Acting insulin detemir (Levemir), insulin glargine
Onset: between 2 and 4 hours
Peak: long acting insulin has a continuous, “peakless” action that mimics the way your body normally
releases insulin
Duration: last up to 24 hours
In 2015 an inhaled insulin product, Afrezza, became available in the U.S. Afrezza is a rapid-acting
inhaled insulin. Afrezza must be used in combination with injectable long-acting insulin in patients
with type 1 diabetes and in type 2 patients who use long-acting insulin.
Inhaled insulin Technosphere insulin-inhalation system (Afrezza)
Onset: within 12 to 15 minutes
Peak: 30 minutes
Duration: Out of your system in 180 minutes
OTHER INJECTED MEDICATIONS
In addition to pills and insulin, some medications for controlling your blood glucose are injected.
Synthetic amylin pramlintide (Symlin)
Synthetic amylin slows food moving through the stomach. This can decrease appetite and may
cause weight loss. It also reduces glucose production by the liver. This keeps after-meal glucose
levels from going too high.
GLP-1 analogues exenatide (Byetta and Bydureon), liraglutide (Victoza), albiglutide (Eperzan and
Tanzeum), dulaglutide (Trulicity)
GLP-1 analogues stimulate the release of insulin when blood glucose is high and decrease the
amount of glucose produced by the liver. They also slow food’s movement through the stomach,
which decreases appetite and may lead to weight loss.
WHAT IF MY BLOOD GLUCOSE STAYS TOO HIGH?
If your blood glucose levels remain too high, your medication may need to be adjusted. Do not
adjust your medication on your own. Talk to your doctor about possible changes.
More handouts about this and other topics can be found at http:://professional.diabetes.org/PatientEd
For more information visit diabetes.org or call 1-800-DIABETES